谷氨酰胺对肝癌切除术患者炎性反应及肺损伤的影响

Effects of the Glutamine on inflammatory response and lung injury in liver cancer patients after the hepatectomy

目的探讨谷氨酰胺对肝癌切除术患者炎性反应及肺损伤的影响。方法选择2014年1月~2017年1月石家庄市第一医院中心院区收治的101例肝癌患者,按照随机数字表法分为对照组和治疗组,其中对照组50例、治疗组51例。两组患者均给予肝脏肿瘤切除术,治疗组予谷氨酰胺治疗,对照组予等量生理盐水,两组患者均治疗7 d。检测并比较两组治疗前后血清白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)、谷丙转氨酶(ALT)、谷草转氨酶(AST)和外周血CD3^+、CD4^+、CD8^+细胞所占比值。评价并比较两组治疗前后的Murray肺损伤评分(MLIS)和急性生理与慢性健康(APACHEⅡ)评分。结果治疗后,两组血清IL-1、TNF-α水平均低于治疗前,且治疗组低于对照组(P<0.05)。治疗后,两组MLIS评分、APACHEⅡ评分均低于治疗前,且治疗组低于对照组(P<0.05)。治疗后,两组血清ALT、AST水平均高于治疗前,然而治疗组血清ALT、AST水平均明显低于对照组(P<0.05)。治疗后,两组外周血CD3^+、CD4^+细胞所占比值均高于治疗前,两组外周血CD8^+细胞所占比值均低于治疗前,且治疗组外周血CD3^+、CD4^+、CD8^+细胞所占比值变化均优于对照组(P<0.05)。结论肝癌切除术患者应用谷氨酰胺,能够明显抑制炎性反应,减轻肺损伤程度,改善肝功能和机体免疫功能,值得在临床上推广应用。

Objective To study the effect of the Glutamine on inflammatory response and lung injury in liver cancer patients after the hepatectomy. Methods A total of 101 liver cancer patients after the hepatectomy in Central Hospital,the First Hospital of Shijiazhuang City from January 2014 to January 2017 were selected and they were divided into the control group（n = 50） and the treatment group（n = 51） according to random number table method. The treatment group was treated with Glutamine, and the control group was treated with normal saline in the same volume. Both groups were treated for 7 days. The serum Interleukin-1（IL-1）, tumor necrosis factor-α（TNF-α）, glutamic-pyruvic transaminase（ALT）, glutamic oxalacetic transaminase（AST） and proportion of peripheral blood CD3＋, CD4＋, CD8＋of the two groups were compared before and after treatment. The MLIS and APACHE Ⅱ scores of the two groups were compared before and after treatment. Results After treatment, the levels of serum IL-1, TNF-α of the two groups were significantly lower than those before treatment, and those of the treatment group were significantly lower than the control group（P〈0.05）. After treatment, the MLIS and APACHE II scores of the two groups were significantly lower than those before treatment, and scores of the treatment group were significantly lower than the control group（P〈0.05）. After treatment, the serum ALT, AST of the two groups were significantly higher than those before treatment, while the indices of the treatment group were significantly lower than the control group（P〈0.05）. After treatment, the proportions of peripheral blood CD3＋, CD4＋of the two groups were significantly higher than those before treatment, the proportion of peripheral blood CD3＋, CD4＋, CD8＋of the two groups were significantly lower than those before treatment, and the changes of the treatment group were significantly better than the control group（P〈0.05）. Conclusion Application of Glutamine in liver cancer patients with hepatectomy, can inhibit the inflammatory response, reduce the lung injury degree, improve the liver and immune function, and it is worthy clinical promotion.